1 PROJECT SUMMARY: Of the 42 million individuals worldwide with Alzheimer?s disease and related dementias (ADRD), 13% to 57% (5.5 to 24 million individuals) suffer dysphagia or swallowing problems. The sequelae of dysphagia in this vulnerable population include malnutrition, dehydration, and aspiration pneumonia. Since swallowing and breathing share a common anatomical pathway, precise coordination is critical. In normal individuals, swallowing occurs in a well-regulated period between mid-to-late respiratory expiration, which imparts airway protective benefits. In dysphagia, this respiratory-swallowing coordination is lost. Despite the high prevalence of dysphagia in individuals with dementia and the seriousness of the consequences, there are limited diagnostic and therapeutic modalities available. The current standard of care for dysphagia in ADRD is behavioral swallowing therapy with specially-trained speech-language pathologists. Specifically, our research team has recently pioneered a novel cross-system training approach with 4-8 in-clinic sessions that directly optimizes respiratory-swallow timing (RST) through visual biofeedback. However, this training must be done in-clinic and requires large, expensive, bulky, and multi-wired systems. Carry over of functional improvements is impeded by the absence in-home training. New technologies addressing dysphagia specifically ADRD requires significant user-centric design, straightforward operation that is deployable at home with minimal caretaker burden, and robustness. We have previously developed a soft, flexible, and fully wireless throat-deployed wearable sensor capable of continuously tracking respiration and swallowing. We propose adding a vibratory haptic motor to enable a home-based therapy that recapitulates RST therapy after therapist training. This new therapeutic wearable would vibrate gently to stimulate swallowing at home as a strengthening exercise whenever a minimum threshold of swallowing is not met. In addition, the device provides additional feedback that reinforces safe swallows personalized to the wearer?s unique expiratory cadence. First, we will conduct focus groups to enable user-centric design. Then, we propose to validate this sensor in a small cohort of persons with mild AD (Clinician Dementia RatingTM?1). Finally, we will evaluate acceptance of the sensor in a short home trial. This proposal aligns with NIA priorities for this RFA, which aims to develop assistive technologies that are innovative, efficacious, scalable, and low-cost